HomeMy WebLinkAboutMN Life Insurance Policy 6-1-2013
Group Term Life Insurance Policy
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North •St. Paul, Minnesota 55101-2098
Read Your Policy CarefullyRight to Cancel
This policy was issued to the policyholder on the effective It is important to us that you are satisfied with this policy
date shown on the specifications page attached to this after it is issued. If you are not satisfied with this policy,
policy. We promise to pay the benefits provided by this you may cancel it by delivering or mailing a written notice
policy, subject to its conditions, limitations, and or sending a telegram to Minnesota Life Insurance
exceptions. We make this promise and issue this policy in Company (Minnesota Life), 400 Robert Street North, St.
consideration of the application for this policy and the Paul, Minnesota 55101-2098 and returning the policy
payment of the premiums.before midnight of the 30th day after you received this
policy.
Minnesota Life Insurance Company is a subsidiary of
Minnesota Mutual Companies, Inc., a mutual insurance Notice given by mail and return of the policy by mail are
holding company. The policyholder is a member of effective on being postmarked, properly addressed, and
Minnesota Mutual Companies, Inc., which holds its annual postage prepaid. If you return this policy, you will receive,
meetings on the first Tuesday in Marchof each yearat 3 within 10 days of the date we receive a notice of
p.m. local time. The meetings are held at 400 Robert cancellation, a full refund of any premiums you paid.
Upon cancellation of this policy, it will be void as if it had
Street North, St. Paul, Minnesota 55101-2098.
never been issued.
Signed for Minnesota Life Insurance Company at St. Paul,
Minnesota on the effective date.
SecretaryPresident
TABLE OF CONTENTS
Definitions..........................................................................2Termination........................................................................5
Minnesota Continuation Right...........................................6
General Information..........................................................2
Conversion Right...............................................................6
Premiums..........................................................................4
Death Benefit.....................................................................4Additional Information........................................................7
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING
MHC-96-13180Minnesota Life 1
EdF790266-2013
GROUP POLICY SPECIFICATIONS PAGE
GENERAL INFORMATION
POLICYHOLDER:City of Oak Park Heights POLICY NO.:34215-G
ASSOCIATED COMPANIES:All subsidiaries and affiliates reported to Minnesota Life by the policyholder for
inclusion in the policy.
POLICY EFFECTIVE DATE:June1, 2013
POLICY ANNIVERSARY DATE:June1 of each year beginning June 1, 2014.
PREMIUM DUE DATE(S):The first day of each month.
GROUP:
The group is composed of all active full-time employeesof the policyholder and its
associated companies.
ENROLLMENT PERIOD:Not applicable for noncontributory insurance; 30days from the first day of eligibility
for contributory insurance.
WAITING PERIOD:The period commencing with the employee’s date of employment and ending with the
first of the month followingthe employee’s date of employment.
MINIMUM HOURS
PER WEEK REQUIRED:40hours per week.
PLAN OF INSURANCE
EMPLOYEE BENEFIT SCHEDULE
EMPLOYEE TERM LIFE INSURANCE:
Basic Life Insurance
Eligible ClassAmount of Basic Life Insurance
All Employees$50,000
Supplemental Life Insurance
Eligible ClassAmount of Supplemental Life Insurance
All employeesAn amount elected by the employee in increments of $10,000, subject to a
maximum of $300,000.
EMPLOYEE ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE:
Basic and Supplemental Insurance
Eligible ClassAmount of Basic and Supplemental AD&D Insurance
All employeesAn amount equal to the amount of basic and supplemental life insurance for
which the employee is insured under the group policy.
F. MHC-50062A
GENERAL PROVISIONS FOR EMPLOYEE INSURANCE
AGE REDUCTIONS:The amount of basic life and AD&D insurance on an employee age 65 or older
shall be a percentage of the amount otherwise provided by the plan of insurance
applicable to such employee in accordance with the following table:
Age of EmployeeAmount of Insurance
65–69 65%
70and over 50%
Age reductions will apply on the policy anniversary date following an insured
thth
employee's 65and 70birthdays.
RETIREMENT REDUCTIONS:All insurance terminates at retirement, except as provided for under the
portability provisionorexcept as provided for under the Minnesota
Continuation provision.
CONTRIBUTORY/NONCONTRIBUTORY:Basic insurance is noncontributory insurance; supplemental insurance is
contributory insurance.
GUARANTEED ISSUE AMOUNT:Guaranteed issue is the maximumamount of insurance an employee can receive
without evidence of insurability when first eligible under the plan provided
enrollment is made within the enrollment period. The amounts are as follows:
For basic insurance:
All basic insurance is guaranteed issue.
For supplemental insurance:
For employees in an eligible class immediately prior to the effective date
of the group policy:
An amount equal to the amount of contributory insurance for
which the employee was insured under the prior carrier’s group
policy on the day immediately preceding the effective date of this
policy.
For employees who first become eligible after the effective date of this
policy:
$100,000
EVIDENCE OF INSURABILITY:Evidence of insurability is required as stated in the policy and for an amount of
insurance greater than the guaranteed issue amount.
EFFECTIVE DATE OF INCREASES Not Applicable
AND DECREASES DUE TO CHANGE
IN ELIGIBLE CLASSOR EARNINGS:
DEPENDENTS BENEFIT SCHEDULE
DEPENDENTS TERM LIFE INSURANCE:
Spouse Life Insurance
Eligible ClassAmount of Spouse Life Insurance
All EmployeesAn amount elected by the employee, in incrementsof $10,000, subject to a
maximum of $150,000.
F. MHC-50062B
Spouse AD&D Insurance
EligibleClassAmount of Spouse Life Insurance
SpousesAn amount equal to the amount of spouse life insurance for which the spouse is
insured under the group policy.
Child Life Insurance
Eligible ClassAmount of Child Life Insurance
Children
Age 14 days to six months$ 1,000
Age six months and older$10,000
Child AD&D Insurance
Eligible ClassAmount of Child Life Insurance
ChildrenAn amount equal to the amount of child life insurance for which the child is
insured under the group policy.
Packaged Dependents Term Life Insurance (does not include AD&D)
Employees who have coverage under this packaged dependent plan on May 31, 2013 will be grandfathered. In addition to having
this coverage, employees mayalso choose to elect spouse and child coverage as noted above. This packaged dependent plan will not
be available effective June 1, 2013.
Eligible ClassAmount of Term Life Insurance
Spouse$10,000
Children
14 days to six months$100
Six months and older$5,000
GENERAL PROVISIONS FOR DEPENDENTS INSURANCE
CONTRIBUTORY/NONCONTRIBUTORY:Dependents insurance is contributory insurance.
GUARANTEED ISSUE AMOUNT:Guaranteed issue is the maximumamount of insurance an eligible dependent
can receive without evidence of insurability when first eligible under the plan
provided enrollment is made within the enrollment period. The amounts are as
follows:
For employees with eligible dependents immediately prior to the effective date
of this policy, the guaranteed issue amount is equal to the amount of dependents
insurance for which they were insured under the prior group policy.
For employees who first become eligible for dependents insuranceafter the
effective date of this policy, the guaranteed issue amount is as follows:
For spouse insurance: $30,000
For child insurance: All child coverage is guaranteed issue.
EVIDENCE OF INSURABILITY:Evidence of insurability is required as stated in the policy and for an amount of
insurance greater than the guaranteed issue amount.
EFFECT OF EMPLOYEE’S RETIREMENT:All dependents insurance terminates upon the employee’s retirement except as
provided under the portability provisionorexcept as provided for under the
Minnesota Continuation provision.
F. MHC-50062C
ADDITIONAL INFORMATION
SUICIDE EXCLUSION FOR LIFE Applies only to employee supplemental lifeand spouse lifeinsurance under this
INSURANCE:
policy. Exclusions for AD&D insurance, including a suicide exclusion, are
listed on the applicable policy rider.
WAIVER OF PREMIUM APPLICATION:Applies to contributory and noncontributory employee insurance.
RIDER(S) TO THE GROUP POLICY
Accelerated Benefits
Accidental Death and Dismemberment
Dependents
Portability
Waiver of Premium
F. MHC-50062D
leaves of absence for non-medical reasons.
Definitions
Non-work day does not include time off for medical leave
age
of absence, temporary layoff, employer suspension of
operations in total or in part, strike, and any time off due to
Attained age as of most recent birthday.
sickness or injury including sick days, short-term disability,
or long-term disability.
associated company
noncontributory insurance
Any company which is a subsidiary or affiliate of the
policyholder which is designated by the policyholder and
Insurance for which an employee is not required to make
agreed to by us to participate under this policy.
premium contributions.
certificate effective date
policy anniversary
The date the insured's coverage under this policy
The policy anniversary date shown on the specifications
becomes effective.
page attached to this policy.
certificate holder
policy effective date
An employee who is eligible for and becomes insured
The date this policy was issued as shown on the
according to the terms of this policy.
specifications page attached to this policy.
contributory insurance
policyholder
Insurance for which an employee is required to make
The owner of the group policy as shown on the
premium contributions.
specifications page attached to the group policy.
earnings
specifications page
An employee’s basic rate of compensation not including
The outline which summarizes the policyholder’s plan of
commissions, overtime or premium pay, bonuses, or any
insurance.
other additional compensation.
waiting period
employee
The period, if any, of continuous employment with the
An individual who is employed by the policyholder or by an
employer required prior to becoming eligible for coverage
associated company. A sole proprietor will be considered
under this policy. The waiting period is shown on the
the employee of the proprietorship. A partner in a
specifications page attached to this policy.
partnership will be considered an employee so long as the
partner’s principal work is the conduct of the partnership’s
we, our, us
business. The term employee does not include temporary
employees nor corporate directors who are nototherwise
Minnesota Life Insurance Company.
employees.
you, your
employer
The policyholder named on the specifications page
The policyholder or any designated associated
attached to this policy.
companies.
General Information
evidence of insurability
What is your agreement with us?
Evidence satisfactory to us of the good health of the
prospective insured and any other underwriting
This policy and your application contain the entire contract
information we require.
between you and us. Any statements you make will, in
the absence of fraud, be considered representations and
insured
not warranties. Also, any statement that you make will not
A person who is eligible for and becomes insured be used to void this policy, nor will it be used in our
according to the terms of this policy.defenseif we refuse to pay a claim, unless the statement
is contained in your application.
non-work day
No change or waiver of any provisions of this policy, or
A day on which the employee is not regularly scheduled to
any certificate issued under it, will be valid unless made in
work, including scheduled time off for vacations, personal
writing by us and signed by our president, a vice-
holidays, weekends and holidays, and approved
president, our secretary, or an assistant secretary. No
agent or other person has the authority to change or waive
MHC-96-13180.22Minnesota Life 2
EdF790266-2013
any provisions of this policy, or of any certificate issued or she will not be eligible for the coverage or increase until
he or she returns to active work. However, if the absence
under it.
is on a non-work day, coverage will not be delayed
Are employees of associated companies eligible for
provided the employee was actively at work on the work
insurance under thispolicy?
day immediately preceding the non-work day.
Yes. Employees of associated companies may be eligible
Except as otherwise provided for in this policy, an
for insurance under this policy. Associated companies are
employee is eligible to continue to be insured only while
shown on the specifications page attached to this policy.
he or she remains actively at work.
You represent any associated company in all transactions
When will we require evidence of insurability?
pertaining to this policy. Your acts or omissions and every
notice given by usto you shall be binding on every
Evidence of insurability will be required if:
associated company.When an associated company
ceases its participation under the policy, the policy shall
(1)the specifications page attached to this policy
be considered to be terminated for all employees ofthe
states that evidence of insurability is required; or
associated company. All provisions related to the policy
(2)the insurance is contributory and the employee
terminating will apply to such employees.
does not enroll within the enrollment period shown
on the specifications page attached to this policy;
Can this policy be amended?
or
(3)the insurance for which the employee previously
Yes. The insured's consent is not required to amend this
enrolled did not go into effect or was terminated
policy or any certificates issued under it. Any amendment
because the employee failed to make a required
will be without prejudice to any claim for benefits incurred
premium contribution; or
prior to the effective date of the amendment.
(4)during a previous period of eligibility, the
Who is eligible for insurance?
employee failed to submit required evidence of
insurability or that which was submitted was not
An employee is eligible if he or she:
satisfactory to us; or
(5)the employee is insured by an individual policy
(1)is a member of the group and of an eligible class
issued under the terms of the conversion right
as shown on the specifications pageattached to
section.
this policy; and
(2)works for the employer for at least the number of
When does insurance become effective?
hours per week shown as the minimum hours per
week requirement on the specifications page
Insurance becomes effective on the date that all of the
attached to this policy; and
following conditions have been met:
(3)has satisfied the waiting period as shown on the
specifications page attached to this policy; and
(1)an employee meets all eligibility requirements;
(4)meets the actively at work requirement as shown
and
in the section entitled “What is the actively at work
(2)if required, the employee applies for the insurance
requirement?”.
on forms which are approved by us; and
(3)we are satisfied with the employee's evidence of
Are retired employees eligible for insurance?
insurability, if we require evidence; and
(4)we receive the required premium.
If the policyholder’s plan of insurance, as reflected in the
specifications page attached to this policy, does not
Can an insured employee's coverage be continued
specifically provide insurance for retired employees, a
during sickness, injury, leave of absence or temporary
retired employee shall not be eligible to become insured,
layoff?
nor have his or her insurance continued. If the
policyholder’s plan of insurance specifically provides
Yes. Insurance may be continued on an insured
insurance for retired employees, the minimum hours per
employee who is not actively at work due to sickness,
week and actively at work requirements will not apply to
injury, leave of absence or temporary layoff, subject to the
such persons.
employer's practices and procedures, including the
employer's limits on the length of continuation allowed for
What is the actively at work requirement?
the type of absence.Continuation is contingent upon
continued premium payment and is subject to the
To be eligible to become insured or to receive an increase
following maximum time frames:
in the amount of insurance, an employee must be actively
at work fully performing his or her customary dutiesfor his
(1)for an employee on non-medical leave of absence
or her regularly scheduled number of hours at the
or temporary layoff, insurance cannot be
employer’s normal place of business, or at other places
continued beyond 12 months from the last day the
the employer’s business requires him or her to travel. If
insured employee was actively at work.
the employee is not actively at work on the date coverage
(2)for an employee on a medical leave of absence,
would otherwise begin, or on the date an increase in his or
insurance cannot be continued beyond the later of
her amount of insurance would otherwise be effective, he
12 months from the last day the insured employee
MHC-96-13180.22Minnesota Life 3
EdF790266-2013
was actively at work or the date the employee date. The insurance under this policy will remain in effect
attains age 65. during the 31-day grace period. This grace period does
not apply to the first premium payment.
Continuation of insurance must be in accordance with
Can the premium be adjusted?
practices and procedures that preclude individual
selection.
Yes. We will adjust the premium on each due date for
insurance which was effective or terminated before the
Coverage during a leave of absence and upon return from
most recent due date, but not reflected in prior premium
a leave of absence shall meet all state and federal
payments. We will charge you for any additional premium,
requirements. The above limits will be expanded if
and will refund any overpayment, excluding any
necessary in order to meet such requirements.
overpayment made more than 12 monthsbefore the
adjustment.
Premiums
Death Benefit
When and how often are premiumsdue?
What is the amount of the death benefit?
Unless we have agreed to some other premium payment
procedure, premiums for this policy are remitted to us
The amount of the death benefit is the amount of
monthly. Premiums are due on the premium due date as
insurance shown on the specifications page attached to
shown on the specifications page attached to this policy.
this group policy.
We apply premiums consecutively to keep the insurance
in force.
Can an insured request a change in the amount of his
or her contributoryinsurance?
You may pay premiums before they are due for any period
up to the next policy anniversary. Premiums paid in
Yes. If the policyholder’s plan of insurance, as reflected in
advance should be calculated at the rate of the monthly
the specifications page attached to this policy, allows for a
premium currently due.
choice of amounts of insurance for an insured’s class, an
insured can request an increase or a decrease in the
Premium contributions for contributory insurance are to be
amount of his or her contributory insurance within the
paid to you. The premium contributions by insureds for
limitations of the policyholder’s plan of insurance,
contributory insurance should be remitted to us as due
including any limitations on when and how often such
along with the premiums payable for noncontributory
requests may be made.
insurance.
If an insured requests an increase in the amount of his or
How is the premium determined?
her contributory insurance, we will require evidence of
The premium will be the premium rate multiplied by the insurability, unless otherwise noted on the specifications
number of $1,000 units of insurance in force on the date page.
premiums are due. The premium may also be computed
When will changes in an insured’s coverage amount
by any other method on which you and we agree.
be effective?
We may change the premium rate:
Requested increases in the amount of an insured’s
(1)on any premium due date following the expiration contributory insurance, if approved, are effective on the
of any rate guarantee period, or following the date date we approve the increase. Requested decreases in
that the amount of insurance in force for any one the amount of an insured’s contributory insurance are
coverage changes by more than 15% from that effective on the first day of the month following receipt of
which was used to determine the current rates the insured’s request for a decrease, or if different,
(active employee coverage and retiree coverage according to the administrative practices of the employer.
are considered separate coverages, as are basic
Requests for a change made during a special enrollment
life, supplemental life, spouse life, child life and
period offered by the employer will not become effective
AD&D); or
prior to the general effective date of elections made during
(2)anytime, if the policy terms are amended or the
that enrollment.
total amount of insurance in force changes by
15% from the volume that was used to determine
Increases and decreases in insurance amounts which
the current rates or more.
result from a change in the insured’s eligible class or
earnings will be effective as shown on the specifications
Can a premium be paid after the date it is due?
page attached to this policy.
Yes. This policy has a 31-day grace period. If a premium
All increases in the amount of insurance are subject to the
is not paid on or before the date it is due, that premium
actively at work requirement.
may be paid during the 31-day period following the due
MHC-96-13180.22Minnesota Life 4
EdF790266-2013
When will the death benefit be payable?(3)the insured has not assigned the ownership of his
or her insurance.
We will pay the death benefit within two months of receipt
at our home office of written proof satisfactory to us that
A request to add or change a beneficiary must be made in
an individual died while insured under this policy. All
writing. All requests are subject to our approval. A
payments by us are payable from our home office.
change will take effect as of the date it is signed, but will
not affect any payment we make or action we take before
If the insured’s amount of insurance is equal to or greater
receiving an insured's notice.
than $15,000, alternative methods of payment other than
a lump sum payment are available at the request of the
Termination
insured’s beneficiary or beneficiaries.
When does an insured’s coverage terminate?
We will pay interest on the death benefit from the date of
the insured’s death until the date of payment. Interest will
The insured's coverage ends on the earliest of the
be at an annual rate determined by us, but never less than
following:
0.1% per year compounded annually, or the minimum
required by state law, whichever is greater.
(1)the date this policy ends; or
(2)the date the employee no longer meets the
Payment of the death benefit will extinguish our liability
eligibility requirements; or
under the certificate for which the death benefit has been
(3)the date the policy is amended so the employee is
paid.
no longer eligible; or
(4)31 days (the grace period) after the due date of
To whom will we pay the death benefit?
any premium contribution which is not paid; or
(5)the last day for which premium contributions have
We will pay the death benefit to the beneficiary or
been paid following an employee's written request
beneficiaries. A beneficiary is named by an insured to
to cease participation under this policy.
receive the death benefit to be paid at the insured's death.
The insured may name one or more beneficiaries. The
If an insured’s coverage under this policy terminates due
insured cannot name you or an associated company as a
to non-payment of premiums, his or her coverage may be
beneficiary.
reinstated if all premiums due are paid and received by us
within 31 days of the date of termination and during the
The insured may also choose to name a beneficiary that
insured’s lifetime.
the insured cannot change without the beneficiary’s
consent. This is called an irrevocable beneficiary.
Can insurance on the life of an insured be reinstated
after termination?
If there is more than one beneficiary, each will receive an
equal share, unless the insured has requested another
Yes. When an insured’s coverage terminates because he
method in writing. To receive the death benefit, a
or she is no longer eligible, and the insured becomes
beneficiary must be living on the date of the insured's
eligible again within three months after the date his or her
death. In the event a beneficiary is not living on the date
coverage terminated, the insured’s coverage under this
of the insured’s death, that beneficiary’s portion of the
policy may be reinstated.
death benefit shall be equally distributed to the remaining
surviving beneficiaries. In the event of the simultaneous
Provided the insured isnot then covered by an individual
deaths of the insured and a beneficiary, the death benefit
policy issued under the terms of the conversion right
will be paid as if the insured survived the beneficiary.
section, his or her coverage under this group policy shall
be reinstated automatically, without evidence of
If there is no eligible beneficiary, or if the insured does not
insurability or satisfaction of any waiting period. The
name one, we will pay the death benefit to:
amount of insurance will be that which applies to the
classification to which he or she then belongs, on the date
(1)the insured's lawful spouse if living, otherwise;
he or she again becomes eligible. If the policyholder’s
(2)the insured's natural or legally adopted child
plan of insurance provides for contributory insurance
(children) in equal shares, if living, otherwise;
under this policy, an insured’s amount of contributory
(3)the insured's parents in equal shares, if living,
insurance will be limited to that for which he or she was
otherwise;
insured immediately prior to the loss of coverage.
(4)the personal representative of the insured’s
estate.
When does this group policy terminate?
Can an insured add or change beneficiaries?
You may terminate this group policy by giving us 31 days
prior written notice. We reserve the right to terminate this
Yes. An insured can add or change beneficiaries if all of
policy on the earliest of the following to occur:
the following are true:
(1)31 days (the grace period) after the due date of
(1)the insured's coverage is in force; and
any premiums which are not paid; or
(2)we have written consent of all irrevocable
(2)on any subsequent policy anniversary after the
beneficiaries; and
date the number of employees insured is less
MHC-96-13180.22Minnesota Life 5
EdF790266-2013
How long can insurance be continued under the
than any minimum established by us or as
group policy?
required by applicable state law; or
(3)31 days after we provide you with notice of our
The insured employee is eligible to continue his or her
intent to terminate this policy.
insurance under the group policy until the earlier of the
following:
Unless this policy is being replaced by a substantially
similar group term life policy, we will notify the insured 30
(1)he or she obtains insurance under another group
days in advance of any termination of this policy by
policy; or
Minnesota Life. In no event shall the terms of this section
(2)18 months after his or her termination or layoff
extend coverage under this policy more than 120 days
from employment.
beyond the date coverage would otherwise terminate
under the terms of this policy.
What happens to the insurance at the end of the
continuation period?
Can this policy be reinstated?
When the continuation period ends, the insured employee,
No. We will not reinstate this policy after it terminates.
his or her insured spouse, or any of his or her insured
You must submit a new application for a new policy after
dependent children may obtain from us, without evidence
this policy has terminated.
of insurability or interruption of coverage, an individual life
insurance policy which provides the same or substantially
Minnesota Continuation Right
similar benefits. A policy providing reduced benefits at a
reduced premium rate may be accepted by the insured
What is the Minnesotacontinuation right?
employee, his or her insured spouse, or any of his or her
insured dependent children.
An insured employee residing in Minnesota who is laid off
or who terminates employment, including retirement, may
All provisions of the conversion right section shall apply to
elect to continue his or her insurance under the group
this type of conversion except for theprovision entitled
policy, including any insurance he or she has on the lives
“What is the conversion right?.” References to insured in
of his or her spouse and dependent children, provided the
all other provisions of the conversion right section shall
group policy remains in force for any active employee.
mean the insured employee, his or her insured spouse, or
The insured employee is considered laid off from
any of his or her insured dependent children.
employment if there is a reduction in hours to such an
extent that he or she is no longer eligible for insurance
What happens ifan insured dies during the 60-day
under the group policy. Termination does not include
period allowed for election of continuation?
discharge for gross misconduct.
If the insured employee, his or her insured spouse, or any
How does the insured employee continue his or her
of his or her insured dependent children dies during the
insurance under the group policy?
60-day election period and before election was made to
continue or to reject continuation, the insured will be
Upon layoff or termination of employment, the employer
considered to have elected continuation of coverage
shall notify the insured employee of his or her rights under
under the group policy. We will pay a death benefit equal
this section. The employee has 60 days from the later of
to the amount of insurance that could have been
the following to elect coverage:
continued less any premium due as of the date of death.
(1)the date his or her coverage would otherwise
Conversion Right
terminate; or
(2)thedate written notice of the right to continue his
or her insurance is received by the employee.What is the conversion right?
An insured may convert this insurance to a new individual
How will premium contributions for the continued
life insurance policy if all or part of the insured's life
insurance be paid?
insurance under this policy terminates.
Premiums for the continued insurance will be paid by the
The insured may convert up to the full amount of
insured to you and then remitted by you to us. The
terminated insurance if termination occurs because:
amount of the premium charged shall not exceed 102% of
the cost to the plan for such period of coverage for other
(1)he or she moves from one existing eligible class
similarly situated employees with respect to whom neither
to another; or
termination nor layoff has occurred, without respect to
(2)he or she is no longer in an eligible class; or
whether such cost is paid by the employee or the
(3)the policy is terminated; or
employer.
(4)the policy is changed to reduce or terminate the
insurance for that individual.
MHC-96-13180.22Minnesota Life 6
EdF790266-2013
The conversion right is not available if the insured’s Is there a suicide exclusion?
coverage under this policy terminates due to failure to
The specifications page attached to this policy indicates
make, when due, required premium contributions.
what insurance, if any, is subject to the suicide exclusion
The insured may convert his or her insurance to any type
outlined below.
of individualpolicy of life insurance then customarily
When applicable, this suicide exclusion limits our liability
issued by us for purposes of conversion, except term
to an amount equal to the premiums paid for an insured, if
insurance. The individual policy will not include any
that insured, whether sane or insane, dies by suicide
supplemental benefits, including, but not limited to, any
within two years of the effective date of his or her
disability benefits, accidental death and dismemberment
insurance.
benefits, or accelerated benefits.
If there has been an increase in the insured’s amount of
How does an insured convert his or her insurance?
insurance for which he or she was required to apply or for
An insured converts his or her insurance by applying for which we required evidence of insurability, and if the
an individual policy and paying the first premium within 31 insured dies by suicide within two years of the effective
days after the group insurance terminates. No evidence date of the increase, our liability with respect to that
of insurability will be required.increase will be limited to the premiums paid and
attributable to such increase.
How is the premium for the individual policy
When does an insured's insurance become
determined?
incontestable?
We base the premium for the individual policy on the plan
of insurance, the insured's age, and the class of risk to Except for fraud or the non-payment of premiums, after
the insured's insurance has been in force during his or her
which the insured belongs on the date of the conversion.
lifetime for two years from the effective date of his or her
When is the individual policy effective?
coverage, we cannot contest the insured's coverage.
However, if there has been an increase in the amount of
The individual policy takes effect 31 days after the group
insurance for which the insured was required to apply or
insurance provided under this policy terminates.
for which we required evidence of insurability, then, to the
extent of the increase, any loss which occurs within two
What happens if the insured dies during the 31-day
years of the effective date of the increase will be
period allowed for conversion?
contestable.
If theinsured dies during the 31-day period allowed for
Any statements the insured makes in his or her application
conversion, we will pay a death benefit regardless of
will, in the absence of fraud, be considered
whether or not an application for coverage under an
representations and not warranties. Also, any statement
individual policy has been submitted. The death benefit
an insured makes will not be used to void his or her
will be the amount of insurance the insured would have
insurance, nor defend against a claim, unless the
been eligible to convert under the terms of the conversion
statement is contained in the application and any evidence
right section.
of insurability application attached to the insured’s
certificate.
We will return any premium the insured paid for an
individual policy to the insured's beneficiary named under
Can an insured's insurance be assigned?
this group policy. In no event will we be liable under both
this group policy and the individual policy.
Yes. However, we will not be bound by an assignment of
the certificate or of any interest in it unless it is made as a
Additional Information
written instrument, the insured files the original instrument
or a certified copy with us at our home office, and we send
What if an insured’s age has been misstated?
the insured an acknowledged copy.
If an insured’s age has been misstated, the death benefit
We are not responsible for the validity of any assignment.
payable will be that amount to which the insured is entitled
An insured is responsible for ensuring that the assignment
based on his or her correct age.is legal in his or her state and that it accomplishes his or
her intended goals. If a claim is based on an assignment,
A premium adjustment will be made to the premium you
we may require proof of interest of the claimant. A valid
pay for the insured's noncontributory insurance and to the
assignment will take precedence over any claim of a
premium an insured pays for contributory insurance, if
beneficiary.
any, so that the actual premium required at the insured's
correct age is paid.Are you required to maintain records?
Yes. You are required to maintain adequate records of
MHC-96-13180.22Minnesota Life 7
EdF790266-2013
any information necessary for us to administer this policy. Will this policy receive experience credits?
We own the records relating to the insurance provided by
Each year we will determine if this policy will receive an
this policy, and can obtain them from you at any
experience credit.
reasonable time.
Are you our agent?
If a clerical error is made in keeping records on the
insurance under this policy, it will not affect otherwise valid
No. For all purposes of this policy, neither you, an
insurance. A clerical error does not continue insurance
associated company, nor any administrator you appoint is
which is otherwise stopped. If an error causes a change in
our agent. We will not be liable for any of your acts or
premium payment, we will make a fair adjustment.
omissions or those of an associated company or
administrator.
Will a certificate of insurance be provided for each
certificate holder?
Will the provisions of this policy conform with state
law?
Yes. We will provide you with a certificate of insurance for
delivery to each certificate holder. The certificate will
Yes. If any provision in this policy, or in the certificates
include information regarding the principal provisions of
issued under this policy, is in conflict with the laws of the
his or her coverage.
state governing the policy or the certificates, the provision
will be deemed to be amended to conform to such laws.
MHC-96-13180.22Minnesota Life 8
EdF790266-2013
Accelerated Benefits
Policy Rider
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North •St. Paul, Minnesota 55101-2098
Benefits received under this Accelerated Benefits Policy does not include the certificate holder, or a member of the
Rider may be taxable. Certificate holders should seek certificate holder’s immediate family.
assistance from a personal tax advisor prior to requesting
Terminal Condition
an accelerated payment of death benefits.
General Information
What is a terminal condition?
A terminal condition is a condition caused by sickness or
This rider amends the group policy to which it is attached
accident which directly results in a life expectancy of
and is subject to every term, condition, exclusion,
twelve months or less.
limitation, and provision of the group policy unless
otherwise expressly provided for herein.
What evidence do we require of the insured’s terminal
condition?
What does this rider provide?
We must be given evidence that satisfies us that the
This rider provides for the accelerated payment of either
insured’s life expectancy, because of sickness or accident,
the full or a partial amount of an insured’s death benefit
is twelve months or less. That evidence must include
provided under the group policy. If the insured has a
certification by a physician.
terminal condition as defined in this rider, an accelerated
payment of the death benefit may be requested. This
Do we have the right to obtain independent medical
rider does not provide long-term care benefits meeting the
verification?
requirements of sections 62A.46 to 62A.56.
Yes. We retain the right to have the insured medically
Minnesota law sets minimum requirements for life
examined at our own expense to verify the insured’s
insurance contracts where the right to receive accelerated
medical condition. We may do this as often as reasonably
benefitsis contingent upon the insured receiving long-term
required while accelerated benefits are being considered
care services. This rider does not meet those minimum
or paid.
requirements.
Payment of Accelerated Benefit
Definitions
How do we calculate the accelerated benefit?
accelerated benefit
We will multiply the death benefit by the accelerated
The amount of the death benefit we will pay if the insured
benefit factor to determine the accelerated benefit
is eligible under this rider.
available.
death benefit
How do we calculate the accelerated benefit factor?
The amount of the insured’s life insurance as shown on
The accelerated benefit factor will be stated as a
the specifications page attached to the certificate holder’s
percentage of the insured’s death benefit. When we
certificate.
calculate this factor, we will consider the insured’s age
and gender.
immediate family
We will also baseour calculation on certain assumptions,
The certificate holder’s spouse, children, parents,
which we may change from time to time, including but not
grandparents, grandchildren, brothers and sisters,and
limited to assumptions about:
their spouses.
(1)expected future premiums; and
insured
(2)the insured’s life expectancy.
For purposes of this rider, an insured employee, an
insured spouse, or an insured dependent child.
What are the conditions for the payment of an
accelerated benefit?
physician
We will consider the payment of an accelerated benefit,
An individual who is licensed to practice medicine or treat
subject to all of the following conditions:
illness in the state in which treatment is received. This
MHC-96-13184.22Minnesota Life 1
EdF790276-2013
(1)coverage must be in force and all premiums due may ask for further satisfactory evidence that the insured
must be fully paid; andmeets all requirements for the accelerated benefit.
(2)applicationmust be made in writing and in a form
What is the effect on an insured’s coverage of the
which is satisfactory to us. We will tell a certificate
receipt of an accelerated benefit?
holder what form is required; and
(3)the certificate holder must be the sole owner of
If a certificate holder elects to accelerate the full amount of
the certificate; and
an insured’s death benefit, the insured’s coverage and all
(4)the insured’s insurance must not have an
other benefits under the certificate and any certificate
irrevocable beneficiary.
supplements which apply to that insured will end. If the
insured is a certificate holder, any other individual insured
Who may request an accelerated payment of the death
under his or her certificate will be allowed to convert any
benefit?
such insurance to a policy of individual life insurance
according to the conversion right section of the group
A certificate holder may request an accelerated payment
policy to which this rider is attached.
of the insurance on his or her life or on the life of a spouse
or dependent child insured under his or her certificate.
If a certificate holder elects to receive only a partial
accelerated benefit amount available under this rider, the
Is the request for an accelerated benefit voluntary?
remaining death benefit under the certificate must beat
least $25,000.
Yes. An accelerated benefit will be made available on a
voluntary basis only. An accelerated benefit under this
How will we pay the accelerated benefit?
rider is not intended to cause an involuntary reduction of
the death benefit ultimately payable to the named
We will pay the accelerated benefit in one lump sum or in
beneficiary. Therefore, payment of the death benefit
any other mutually agreeable manner.
cannot be accelerated under this rider if the insured:
To whom will we pay accelerated benefits?
(1)is required by law to use this option to meet the
claims of creditors, whether in bankruptcy or
All accelerated benefits will be paid to the certificate
otherwise; or
holder who requested the accelerated payment unless the
(2)is required by a government agency to use this
certificate holder validly assigns them otherwise. If such
option in order to apply for, obtain, or keep a
certificate holder dies before all payments have been
government benefit or entitlement.
made, we will pay the remainder to the insured’s
beneficiary named under the certificate. Payment will be
Is there a minimum or maximum death benefit eligible
made in one lump sum which will be the present value of
for an accelerated benefit?
the payments that remain, using the interest rate we use
to determine the payments.
Yes. The minimum death benefit to be eligible for an
accelerated benefit under this rider is $10,000. The
Termination
maximum death benefit to be eligible for an accelerated
benefit is $1,000,000.
When does an insured’s coverage under this rider
terminate?
Does a certificate holder have to take the entire
accelerated benefit?
An insured’s coverage ends on the date the insured is no
longer covered for life insurance under the group policy.
No. The certificate holder may choose to receive a partial
accelerated benefit. If he or she does so, the insured’s
When does this rider terminate?
remaining coverage will stay in force.
This rider will terminate on the earlier of:
If a certificate holder elects to receive only a partial
accelerated benefit amount available under this rider, the
(1)the date we receive a written request to cancel
remaining death benefit under the certificate must be at
this rider; or
least $25,000.
(2)the date the group policy is terminated.
The certificate holder may reapply for the payment of the
remaining amount of insurance at any time. However, we
SecretaryPresident
MHC-96-13184.22Minnesota Life 2
EdF790276-2013
Accidental Death and Dismemberment
Policy Rider
Minnesota Life Insurance Company,a Securian Financial Group affiliate
400 Robert Street North •St. Paul, Minnesota 55101-2098
General Information
(3)the insured’s commission of or attempt to commit a
felony; or the insured’s being engaged in an illegal
occupation regardless of any legal proceedings, or
This rider is issued in consideration of the required
the absence of any legal proceedings, thereto; or
premium and amends the group policy to which it is
(4)bodily or mental infirmity, illness or disease; or
attached. This rider is subject to every term, condition,
exclusion, limitation, and provision of the group policy
(5)the use of alcohol, drugs, medications, poisons,
unless otherwise expressly providedfor herein.
gases, fumes or other substances taken, absorbed,
inhaled, ingested or injected, unless taken upon
What does this rider provide?
the advice of a licensed physician in the verifiable
prescribed manner and dosage; or
This rider provides accidental death and dismemberment
(6)motor vehicle collision or accident where the
coverage subject to all terms, conditions, and exclusions
insured is the operator of the motor vehicle and this
herein.
insured’s blood alcohol level meets or exceeds the
level at which intoxication is defined in the state
Who is eligible for insurance under this rider?
where the collision or accident occurred,
regardless of any legal proceedings, or the
An employee or a dependent spouseor childwho is
absence of any legal proceedings, thereto; or
eligible under the provisions applicable to life insurance
(7)infection, other than infection occurring
coverage under the group policy is eligible for insurance
simultaneously with, and as a direct result of, the
under this rider.
accidental injury; or
(8)medical or surgical treatment or diagnostic
When does insurance under this rider become
procedures or any resulting complications; or
effective?
(9)travel in or descent from any aircraft, except as a
fare-paying passenger on a regularly scheduled
Insurance becomes effective on the date that the
commercial flight on a licensed passenger aircraft;
employee or dependent spouseor childbecomes insured
or
for life insurance under the group policy.
(10)war or any act of war, whether declared or
Accidental Death and Dismemberment
undeclared; or
(AD&D) Benefit
(11)service in the military of any nation.
What does accidental death or dismemberment by
What is the amount of the accidental death and
accidental injury mean?
dismemberment benefit?
Accidental death or dismemberment by accidental injury
The amount of the benefit shall be a percentage of the
as used in this rider means that the insured’s death or
amount of insurance shown on the specifications page
dismemberment results, directly and independently of all
attached to the group policy. The percentage is
other causes, from an accidental bodily injury which is
determined by the type of loss as shown in the following
unintended, unexpected, and unforeseen. The bodily
table:
injury must be evidenced by a visible contusion or wound,
except in the case of accidental drowning. The bodily
FOR LOSS OFAMOUNT OF BENEFIT
injury must be the sole cause of death or dismemberment.
Life....................................Full Amount of AD&D Insurance
The injury must occur while the insured’s coverage under
Both Hands or Both Feet..Full Amount of AD&D Insurance
this rider is in force. The insured’s death or
Sight of Both Eyes............Full Amount of AD&D Insurance
dismemberment must occur within 180 days after the date
Speech and Hearing.........Full Amount of AD&D Insurance
of the injury and while his or her coverage under this rider
One Hand and One Foot..Full Amount of AD&D Insurance
is in force.
One Foot and Sight
of One Eye........................Full Amount of AD&D Insurance
In no event will we pay the accidental death or
One Hand and Sight
dismemberment benefit where the insured’s death or
of One Eye........................Full Amount of AD&D Insurance
dismemberment is caused directly or indirectly by, results
Quadriplegia.....................Full Amount of AD&D Insurance
from, or where there is a contribution from, any of the
Paraplegia..................75% of Amount of AD&D Insurance
following:
Sight of One Eye........50% of Amount of AD&D Insurance
Speech or Hearing......50% of Amount of AD&D Insurance
(1)self-inflicted injury or self destruction, whether
One Hand or
sane or insane; or
One Foot.....................50% of Amount of AD&D Insurance
(2)suicide or attempted suicide, whether sane or
Hemiplegia..................50% of Amount of AD&D Insurance
insane; or
06-30882.22Minnesota Life 1
EdF790286-2013
Thumb and Indexlosses sustained by a certificate holder will be paid to the
Finger of One Hand.....25% of Amount of AD&D Insurance
certificate holder, if living, otherwise to his or her estate.
Aspouseand child’s AD&D benefit will be paid to the
Loss of hands or feet means complete severance at or
certificate holder, if living, otherwise to his or her estate.
above the wrist or ankle joints. Loss of sight, speech, or
hearing means the entire and irrecoverable loss of sight,
Additional Benefits
speech, or hearing which cannot be corrected by medical
or surgical treatment or by artificial means. Loss of thumb
or finger means complete severance at or above the
Unless stated otherwise, additional benefits are payable to
metacarpophalangeal joints (the joints closest to the palm
the same person or persons who receive the AD&D
of the hand).
benefits. Additional benefits are paid in addition to any
AD&D benefits described in the Accidental Death and
Quadriplegia means total and permanent paralysis of both
Dismemberment section, unless otherwise stated. All
upper limbs (from the shoulder down including total
provisions of this rider, including but not limitedto the
paralysis of both hands) and both lower limbs (from the
"What does accidental death or dismemberment by
waist down including total paralysis of both feet).
accidental injury mean?" section, shall apply to these
Paraplegia means total and permanent paralysis of both
additional benefits.
lower limbs (from the waist down including total paralysis
of both feet). Hemiplegia means total and permanent
Air Bag Benefit
paralysis of both the upper limb (from the shoulder down
including total paralysis of the hand) and lower limb (from
What is the air bag benefit?
the waist down including total paralysis of the foot) on one
side of the body.
If an insured dies as a result of a covered accident which
occurs while he orshe is driving or riding in a private
A benefit is not payable for both loss of one hand and the
passenger car, we will pay an additional AD&D benefit
loss of thumb and index finger of one hand for injury to the
equal to the lesser of:
same hand as a result of any one accident.Under no
circumstance will more than one payment be made for the
(1) $10,000; or
loss or paralysis of the same limb, eye, finger, thumb,
(2)10% of the insured’s amount of AD&D insurance.
hand, foot, sight, speech, or hearing if one payment has
already been made for that loss.
In order to be eligible for this benefit, the following must
apply:
Benefits may be paid for more than one accidental loss
but the total amount of AD&D insurance payable under
(1)the seat in which the insured was seated was
this riderfor all of an insured’s losses due to any one
equipped with a properly installed airbag at the
accident, not including any amount paid according to the
time of the accident; and
terms of the Additional Benefits section of this rider, will
(2)the private passenger car is equipped with
never exceed the full amount of AD&D insurance shown
seatbelts; and
on the specifications page attached to the group policy.
(3)a seatbelt was in proper use by the insured at the
time of the accident as certified in the official
When will the accidental death and dismemberment
accident report or by the investigating officer; and
benefit be payable?
(4)at the time of the accident,the driver of the private
passenger car, was a licensed driver and was not
We will pay the AD&D benefit within two monthsupon
intoxicated, impaired,or under the influence of
receipt at our home office of written proof satisfactory to
alcohol or drugs, and did not meet orexceed the
us that the insured died or suffered dismemberment as a
legal level at which intoxication is defined in the
result of an accidental injury. All payments by us are
state where the collision or accident occurred.
payable from our home office.
The benefit will be paid in a single sum. We will pay Airbag means a passive restraint device in a vehicle which
interest on the benefit from the date of the insured’s death inflates upon collision to protect an individual from injury or
or dismemberment until the date of payment. Interest will
death.
be at an annual rate determined by us, but never less than
Seatbelt means a properly installed seatbelt (or child
0.1% per year compounded annually or the minimum
required by state law, whichever is greater.restraint if the insured is a child), lap and shoulder restraint,
or other restraint approved by the National Highway Traffic
To whom do we pay the benefit?
Safety Administration or any successor governmental
agency. A private passenger car means a validly
A certificate holder’s accidental death benefit will be paid
registered four-wheeled private passenger car or
to the person or persons entitled to receive a death benefit
policyholder-owned car, jeep, pickup truck or van, including
under the terms of the group policy. The benefit for other
a sport utility vehicle (SUV), that is not licensed
06-30882.22Minnesota Life 2
EdF790286-2013
commercially or being used for racing, or acrobatic or
(3) for an insured dependentspouseor child, the date
stunt driving.
the dependentspouse or child is no longer covered
for life insurance under thegroup policy; or
Seatbelt Benefit
(4)31 days (the grace period) after the due date of
any premium contribution which is not paid.
What is the seatbelt benefit?
When does this rider terminate?
If an insured dies as a result of a covered accident which
occurs while he or she is driving or riding in a private
This riderwill terminate on the earlier of:
passenger car, we will pay an additional AD&D benefit
equal to the lesser of:
(1)the date we receive a written request from the
policyholder to cancel this rider; or
(1) $20,000; or
(2)the date the group policy is terminated.
(2) 20% of the insured’s amount of AD&D insurance.
Additional Information
In order to be eligible for this benefit, the following must
apply:
Do we have the right to obtain independent medical
verification?
(1)the private passenger car was equipped with
seatbelts; and
Yes. We retain the right to have an insured medically
(2)a seatbelt was in proper use by the insured at the
examined at our expense whenever a claim is pending and,
time of the accident as certified in the official
where not forbidden by law, we reserve the right to have an
accident report or by the investigating officer; and
autopsy performed in case of death.
(3)at the time of the accident, the driver of the private
passenger car was a licensed driver and was not
Can insurance under this rider be converted to apolicy
intoxicated, impaired, or under the influence of
of individual insurance upon termination?
alcohol or drugs, and did not meet or exceed the
legal level at which intoxication is definedin the
No. Coverage under this rider will not be included in any
state where the collision or accident occurred.
insurance issued under the conversion right section of the
group policy.
Termination
When does an insured’s coverage under this rider
terminate?
SecretaryPresident
An insured’s coverage ends on the earlier of:
(1)the date the certificate holder is no longer covered
for life insurance under the group policy; or
(2)for an insured dependentspouseor child, the date
the dependent spouse or child no longer meets
the eligibility requirements; or
06-30882.22Minnesota Life 3
EdF790286-2013
Dependents Term Life Insurance
Policy Rider
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North •St. Paul, Minnesota 55101-2098
(1)the specifications page attached to the group
General Information
policy states that evidence of insurability is
required; or
This rider is issued in consideration of the required
(2)the insurance is contributory and the employee
premium and amends the group policy to which it is
does not enroll for coverage under this rider within
attached. The rider is subject to every term, condition,
the enrollment period shown on the specifications
exclusion, limitation, and provision of the group policy
page attached to the group policy; or
unless otherwise expressly provided for herein. Any
(3)dependents insurance for which the employee
Accidental Death and Dismemberment coverage provided
previously enrolled did not go into effect or was
by a rider to the group policy will not apply to dependents
terminated because the employee failed to make
coverage provided by this rider.
a required premium contribution; or
What does this rider provide?
(4)during a previous period of eligibility, the
employee failed to submit evidence of insurability
This rider provides insurance on the lives of the insured
that was required for a dependent or that which
employee’s eligible dependents.
was submitted was not satisfactory to us; or
(5)the dependent is insured by an individual policy
What members of the insured employee’s family are
issued under the terms of the conversion right of
eligible for insurance under this rider?
this rider.
The following members of the insured employee’s family
When does insurance on a dependent become
are eligible for insurance under this rider:
effective?
(1)the insured employee’s lawful spouse who is not
Insurance on a dependent becomes effective on the date
legally separated from the insuredand who is not
when all of the following conditions have been met:
eligible for insurance as an employee under the
policy to which this rider is attached; and
(1)the dependent meets all eligibility requirements;
(2)theinsured employee’s children, stepchildren, and
and
legally adopted children, who are unmarriedand
(2)if required, the insured employee applies for
dependent on the insured for financial support.
dependents coverage on forms which are
Children are eligible from 14 days to the
approved by us; and
attainment of age 19, or to the attainment of age
(3)we are satisfied with the dependent’s evidence of
25 if a full-time student in an accredited
insurability, if we require evidence; and
educational institution. Children age 19 or older
(4)we receive the required premium.
are also eligible if they are physically or mentally
incapable of self-support, were incapable of self-
If a dependent is hospitalized or confined because of
support prior to age 19 (25 if a full-time student)
illness or disease on the date his or her insurance would
and are financially dependent on the employeefor
otherwise become effective, his or her effective date shall
more than one-half of their support and
be delayed until he or she is released from such
maintenance.
hospitalization or confinement.However, in no event will
insurance on a dependent be effective before the insured
If both parents of a child qualify as eligible employees
employee’s insurance under the group policy is effective.
under the group policy, the child shall be considered a
dependent of only one parent for purposes of this rider. If
Death Benefit
any child qualifies as an eligible employee under the
group policy, he or she is not eligible to be insured as a
What is the amount of life insurance on each insured
dependent child.
dependent?
Any dependent child who, subsequent to the effective date
The amount of life insurance on each insured dependent
of the insured employee’s child life insurance. meets the
is shown on the specifications page attached to the group
requirements of this provision will become insured on the
policy.
date he or she so qualifies.
To whom will we pay the death benefit?
When will we require evidence of insurability?
The death benefit payable under this rider will be paid to
Evidence of insurability will be required if:
the insured employee if living, otherwise to his or her
estate.
MHC-96-13186Minnesota Life 1
EdF790296-2013
because of the death of the insured employee, or because
Termination
of termination or amendment of this rider, the insurance
may be converted to a policy of individual insurance with
When does an insured dependent’s coverage under
Minnesota Life.
this rider terminate?
Conversion may be requested by the insured employee,
An insured dependent’s coverage ends on the earliest of
an insured dependent of legal capacity, or the insured
the following:
dependent’s guardian, if applicable. All other conditions
and provisions of the conversion right section of the group
(1)the date the dependent no longer meets the
policy to which this rider is attached will apply.
eligibility requirements; or
(2)31 days (the grace period) after the due date of
Does the Waiver of Premium rider to the group policy
any premium contribution which is not paid; or
apply to insured dependents?
(3)the last day for which premium contributions have
been made following an employee’s written
The Waiver of Premium rider to the group policy will not
request that insurance on his or her eligible
apply to disabilities for dependents covered under this
dependents be terminated; or
rider.
(4)the date the employee is no longer covered under
the group policy.
However, if, due to the insured employee’s disability, his
or her insurance is continued in force without further
The employee must notify us or the employer when a
payment of premiums due to the Waiver of Premium rider
dependent is no longer eligiblefor coverage under this
to the group policy, any dependents insurance provided by
rider so that premiums may be discontinued. All
this rider shall also continue in force without further
premiums paid for dependents who are no longer eligible
payment of premiums until the dependent’s eligibility
for coverage under this rider will be refunded without any
terminates or until the insured employee’s insurance is no
payment of claim.
longer continued in force due to the Waiver of Premium
rider to the group policy.
When does this rider terminate?
This provision is not applicable if the dependent’s
This rider will terminate on the earlier of:
insurance has been converted under the conversion right
section of this rider, unless the converted policy is
(1)the date we receive a written request to cancel
surrendered without claim except for refund of premiums.
this rider; or
(2)the date the group policy is terminated.
Additional Information
What is the conversion right under this rider?
SecretaryPresident
If an insured dependent’s coverage under this rider
terminates because he or she is no longer eligible, or
MHC-96-13186Minnesota Life 2
EdF790296-2013
Term Life Insurance Portability
Policy Rider
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North •St. Paul, Minnesota 55101-2098
What insurance can be continued under this rider?
General Information
Contributoryand non-contributory life insurance may be
This rider is issued in consideration of the required
continued under this rider. If the certificate holder elects
premium and amends the group policy to which it is
to continue his or her own coverage according to the
attached. This rider is subject to every term, condition,
provisions of this rider, he or she may also elect to
exclusion, limitation and provision of the group policy
continue contributory insurance for any other individual
unless otherwise expressly provided for herein.
insured under his or her certificate. The certificate holder
may also continue coverage under all supplements to
What does this rider provide?
such certificate which apply to contributory insurance and
by which he or she was insured immediately preceding his
This rider provides for continuation of group life insurance
or her portability date, except the Accidental Death and
for insureds who nolonger meet the eligibility
Dismemberment Certificate Supplement and the Term Life
requirements of the group policy except as provided for
Waiver of Premium Certificate Supplement, which shall
herein.
terminate upon porting.
To continue coverage under the provisions of this rider, an
The amount of insurance continued under this rider for
eligible insured must make a written request and make the
any individual will be subject to any applicable state law or
first premium contribution within 31 daysafter insurance
regulation relating to allowable amounts of insurance.
provided by the group policy would otherwise terminate.
Evidence of insurability will not be required. Coverage
What is the minimum amount of insurance that can be
provided by this rider will then be deemed effective
continued under this rider?
retroactive to the beginning of the 31-dayperiod. This
date is considered to be the insured’s portability date and
The minimum amount of insurance that can be continued
the insured is then considered to have portability status.
on the life of a certificate holder under this rider is
$10,000. The minimum does not apply to any other
Who is eligible to continue insurance under this rider?
insureds covered under this rider.
A certificate holder is eligible to continue insurance under
What is the maximum amount of insurance that can
this rider if he or she, except as provided by this rider, no
be continued under this rider?
longer meets the eligibility requirements of the group
policy due to any of the following:
The maximum amount of insurance that can be continued
under this rider is the amount of insurance that was in
(1)the employee terminates employment, including
force on the insured’s portability date, but not more than
retirement; or
$500,000 for an employee or $150,000 for a spouse.
(2)the employee is no longer in a class eligible for
However, for an insured who is age 65 or older on his or
insurance or is on a leave or layoff; or
her portability date, the amount will not be more than65%
(3) a class or group of employees insured under the
of the amount in force on the insured’s portability date, to
policy is no longer considered eligible and there is
a maximum of $325,000for an employee or $97,500 for a
no successor plan for that class or group.
spouse.
Successor plan means an insurance policy or
policies provided by us or another insurer that
Will the amount of insurance continued under this
replaces insurance provided under this policy.
rider change?
The certificate holder will not be eligible to request
Yes. When an insured attains age 65, the amount of
coverage under this rider if he or she:
insurance on his or her life continued under this rider will
reduce to 65% of the amount of insurance in force on the
(1)has attained the age of 70; or
day prior to his or her attainment of age 65. Insurance
(2)has converted his or her insurance to an individual
terminates at age 70.
life policy under the terms of the group policy’s
conversion right section; or
Can a certificate holder request a change in his or her
(3)was not actively at work due to sickness or injury
amount of insurance continued under this rider?
on the day immediately preceding his or her
portability date; or
Yes. The certificate holder may elect to reduce the
amount of insurance provided under his or her certificate.
(4)loses eligibility due to termination of the group
The remaining amount of insurance on the life of a
policy.
certificate holder must be at least $10,000.
MHC-96-13214Minnesota Life 1
EdF790306-2013
What happens to insurance provided under this rider
The amount of insurance continued under this rider will
when the group policy terminates?
never increase.
How will premium contributions be paid?Anything in the group policy notwithstanding, termination
of the group policy by the policyholder or us will not
Premium contributions will be paid directly to us on a
terminate life insurance then in force for any person under
monthly, quarterly, semi-annual, or annual basis and will
the terms of this rider. The group policy will be deemed to
be subject to an administrative charge per billing period.
remain in force solely for the purpose of continuing such
We may adjust the amount of the charge, but not more
insurance, but without further obligation of the
often than once per year.
policyholder.
Can the premium rate change?
Any insurance continued under the terms of this rider will
remain in force until terminated by the provisions of the
Yes. The premium rate may increase on the portability
section entitled “When will insurance continued under this
date. The premium rate may also increase in the future
rider terminate?”.
but will not change more often than once per year.
No individual may elect coverage under this rider on or
Can insurance continued under this rider be
after the date of termination of the group policy.
converted to a policy of individual insurance?
When will insurance continued under this rider
Yes. At any time after insurance has been continued
terminate?
under the provisions of this rider, it may be converted to a
policy of individual insurance with Minnesota Life. All
Insurance continued under this rider will terminate on the
other conditions and provisions of the conversion right
earliest of the following:
section of the group policy to which this rider is attached
(1)the insured’s 70th birthday; or
will apply.
(2)the date the certificate holder again meets the
What happens if a certificate holder again becomes
eligibility requirements of the group policy, not
eligible under the group policy?
including the terms of this rider; or
(3)in the case of a dependent child or a spouse who
If a certificate holder who is continuing coverage under the
is insured by a rider to the certificate holder’s
provisions of this rider again meets the eligibility
coverage, the date the certificate holder’s
requirements of the group policy, not including the terms
coverage is no longer being continued under this
of this rider, he or she shall no longer be considered to
rider, or the date the certificate holder’s spouse or
have portability status. Insurance for that certificate holder
child ceases to be eligible as defined under the
may be provided only under the terms of the group policy,
terms of the group policy; or
not including this rider, unless and until he or she no
(4)31 days after the due date of any premium
longer meets the eligibility requirements of the group
contribution which is not made.
policy and again returns to portability status as provided
for herein.
SecretaryPresident
MHC-96-13214Minnesota Life 2
EdF790306-2013
Term Life Waiver of Premium
Policy Rider
Minnesota Life Insurance Company - A Securian Company
400 Robert Street North •St. Paul, Minnesota 55101-2098
Do premiums have to be paid for a certificate holder
General Information
after he or she becomes disabled?
This rider is issued in consideration of the required
Yes. Premiums have to be paid after a certificate holder
premium and amends the group policy to which it is
becomes disabled, but only until we approve his or her
attached. The specifications page attached to the group
total and permanent disability claim. Continued payment
policy indicates whether this rider applies to contributory
prevents the possible loss of the certificate holder’s
insurance or noncontributory insurance. This rider is
coverage and eligibility if theclaim is not approved.
subject to every term, condition, exclusion, limitation, and
provision of the group policy unless otherwise expressly
What if a certificate holder converts his or her group
provided for herein. Coverage under this rider will not be
life insurance to a policy of individual insurance prior
included in any insurance issued under the conversion
to the approval of his or her disability claim?
right section of the group policy.
If a certificate holder’s coverage has been converted in
What does this rider provide?
accordance with the conversion right section of the group
policy, benefits under this rider will apply only if the
This rider provides for waiver of premium for certificate
converted policy is surrendered without claim, except for
holders who become totally and permanently disabled, as
refund of premiums.
defined herein, while under age 60. Upon approval of
proof of such disability, a certificate holder’s insurance,
What will be considered due proof of total and
including all riders applicable to such certificate holder
permanent disability?
which were in force on the date of the onset of the
certificate holder’s disability, will be continued in force
A certificate holder must furnish evidence satisfactory to
without payment of premiums during the uninterrupted
us that his or her disability:
continuance of the total and permanent disability.
(1)commenced while his or her insurance under the
What is total disability?
group policy was in force; and
(2)meets the definition of total disability; and
Total disability is a disability which occurs while a
(3)commenced before his or her 60th birthday; and
certificate holder’s insurance and the coverage under this
(4) was continuous for sixmonths or more.
rider is in force and which results from an accidental injury
or an illness that continuously prevents the certificate
We will, from time to time, also require additional proof
holder from engaging in any occupation for which he or
satisfactory to us that the certificate holder continues to be
she is reasonably suited by education, training, or
totally and permanently disabled. We may also require
experience. The certificate holder must be under the care
that the certificate holder submit to oneor more medical
of a licensed physician. The licensed physician cannot be
examinations at our expense.
the certificate holder or a member of the certificate
holder’s immediate family. For purposes of this rider, the
If a certificate holder dies within one year of the date of
certificate holder’s immediatefamily consists of his or her
onset of his or her disability, the certificate holder’s
spouse, children, parents, grandparents, grandchildren,
beneficiary may claim benefits under this rider even if the
brothers and sisters and their spouses.
certificate holder’s premium payments were discontinued
and he or she had not submitted due proof satisfactory to
What is permanent disability?
us of his or her total disability or was continuously
disabled for less thansixmonths. The certificate holder’s
Permanent disability is a total disability which has existed
beneficiary must submit due proof satisfactory to us that
continuously for at least sixmonths.
the certificate holder’s total disability, which began before
the certificate holder’s premium payments were
Are there any limitations?
discontinued and before his or her 60th birthday,
continued without interruption until his or her death.
Yes. Insurance will not be continued if a certificate
holder’s disability results from intentionally self-inflicted
When must we be notified of a certificate holder’s
injury, participation in or any attempt to commit a felony, or
disability or death?
war or any act of war, whether declared or undeclared.
We must receive written notice at our home office of a
certificate holder’s total disability within one year of the
MHC-96-13208Minnesota Life 1
EdF790316-2013
date of onset of such disability. However, failure to give for an employee whose insurance is being continued by
notice within the time provided will not invalidate the claim the terms of this rider shall be the earlier of:
if it is shown that notice was given as soon as reasonably
(1)the date he or she actually retires; or
possible.
(2)his or her presumed normal retirement date as
established by the employer’s applicable
We must receive written notice at our home office within
retirement plan. If no such date has been
one year of death that a certificate holder died during a
established, the insured employee’s presumed
period of continuance provided by this rider. Proof must
retirement date shall be age 65.
befurnished that he or she continued to be totally disabled
during the entire period of continuance until death. If such
What happensto a certificate holder’s insurance when
notice and proof are not provided within the required time
the waiver of premium benefit ends?
frame, there shall be no liability for any payment under this
rider.
When the benefits under this rider end according to the
provisions of the section entitled “How long will insurance
What isthe amount of insurance to be continued
be continued without payment of premium?,” the following
without payment of premium under this rider?
will apply:
The amount of insurance continued without payment of
(1)If the certificate holder is then eligible for coverage
premium shall be the amount of insurance that was in
under the group policy, his or her insurance may
force on the date of onset of total disability.
be continued under the group policy provided that
premiums are paid. The first such premium
If the group policy provides for reductions in amounts of
payment must be made within 31 days of the date
insurance based on ageor retirement, such reductions
thewaiver of premium benefit ends.
shall apply to the insurance of the disabled certificate
(2)If the certificate holder is no longer eligible for
holder. coverage under the group policy, he or she may
convert coverage to an individual policy, as
provided for under the conversion right section of
How long will insurance be continued without
the group policy.
payment of premium?
Insurancewill end for a certificate holder unless, within 31
If a certificate holder becomes totally and permanently
days of the date benefits under this rider end, premium
disabled, insurance will be continued, without payment of
payment is resumed or the insured applies to convert his
premium, until the earliest of:
or her coverage.
(1)the certificate holder’s 65th birthday; or
When does this rider terminate?
(2)the date the certificate holder recovers so that he
or she is no longer totally and permanently
disabled; or
This rider will terminate on the earlier of:
(3)the date the certificate holder fails to furnish proof
of continued disability when requested or refuses (1)the date we receive a written request to terminate
this rider; or
to submit to a required medical examination.
(2)the date the group policy is terminated.
However, if the group policy provides for termination of
insurance at retirement, insurance provided under this Insurance being continued without further payment of
rider will terminate when the insured employee retires, premiums in accordance with the provisions of this rider
including normal or early retirement. The retirement date will not end due solely to the termination of this rider or of
the group policy.
SecretaryPresident
MHC-96-13208Minnesota Life 2
EdF790316-2013
400 Robert Street North • St. Paul, Minnesota 55101-2098
GROUP TERM LIFE INSURANCE POLICY • NONPARTICIPATING